Tan MS; Patel BK; Roughead EE; Ward M; Reuter SE; Roberts G; Andrade AQ

Author(s)

Tan MS

Patel BK

Roughead EE

Ward M

Reuter SE

Roberts G

Andrade AQ

Publication Date

2023-10-11

Abstract

INTRODUCTION: This study aimed to identify opportunities for clinical decision support targeting medication safety in remote primary care, by investigating the relationship between clinical workflows, health system priorities, cognitive tasks, and reasoning processes in the context of medicines used in people with chronic kidney disease (CKD). METHODS: This qualitative study involved one-on-one, semistructured interviews. The participants were healthcare professionals employed in a clinical or managerial capacity with clinical work experience in a remote health setting for at least 1 year. RESULTS: Twenty-five clinicians were interviewed. Of these, four were rural medical practitioners, nine were remote area nurses, eight were Aboriginal health practitioners, and four were pharmacists. Four major themes were identified from the interviews: (1) the need for a clinical decision support system to support a sustainable remote health workforce, as clinicians were "constantly stretched" and problems may "fall through the cracks"; (2) reliance on digital health technologies, as medical staff are often not physically available and clinicians-on-duty usually "flick an email and give a call so that I can actually talk it through to our GP"; (3) knowledge gaps, as "it takes a lot of mental space" to know each patient's renal function and their medication history, and clinicians believe "mistakes can be made"; and (4) multiple risk factors impacting CKD management, including clinical, social and behavioural determinants. CONCLUSIONS: The high prevalence of CKD and reliance on digital health systems in remote primary health settings can make a clinical decision support system valuable for supporting clinicians who may not have extensive experience in managing medicines for people with CKD.

Affiliation

Faculty of Health, Charles Darwin University, Darwin, NT, Australia. RINGGOLD: 10095

Medicines Management Unit, Department of Health, Northern Territory Government, Darwin, NT, Australia. RINGGOLD: 1137

Quality Use of Medicine and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.

College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia. RINGGOLD: 198094

Citation

J Telemed Telecare. 2023 Oct 11:1357633X231204545. doi: 10.1177/1357633X231204545.

OrcId

0000-0001-5691-2795

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/37822219/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/12548

Title

Opportunities for clinical decision support targeting medication safety in remote primary care management of chronic kidney disease: A qualitative study in Northern Australia.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Tan MS Patel BK Roughead EE Ward M Reuter SE Roberts G Andrade AQ
Publication Date	2023-10-11
Abstract	INTRODUCTION: This study aimed to identify opportunities for clinical decision support targeting medication safety in remote primary care, by investigating the relationship between clinical workflows, health system priorities, cognitive tasks, and reasoning processes in the context of medicines used in people with chronic kidney disease (CKD). METHODS: This qualitative study involved one-on-one, semistructured interviews. The participants were healthcare professionals employed in a clinical or managerial capacity with clinical work experience in a remote health setting for at least 1 year. RESULTS: Twenty-five clinicians were interviewed. Of these, four were rural medical practitioners, nine were remote area nurses, eight were Aboriginal health practitioners, and four were pharmacists. Four major themes were identified from the interviews: (1) the need for a clinical decision support system to support a sustainable remote health workforce, as clinicians were "constantly stretched" and problems may "fall through the cracks"; (2) reliance on digital health technologies, as medical staff are often not physically available and clinicians-on-duty usually "flick an email and give a call so that I can actually talk it through to our GP"; (3) knowledge gaps, as "it takes a lot of mental space" to know each patient's renal function and their medication history, and clinicians believe "mistakes can be made"; and (4) multiple risk factors impacting CKD management, including clinical, social and behavioural determinants. CONCLUSIONS: The high prevalence of CKD and reliance on digital health systems in remote primary health settings can make a clinical decision support system valuable for supporting clinicians who may not have extensive experience in managing medicines for people with CKD.
Affiliation	Faculty of Health, Charles Darwin University, Darwin, NT, Australia. RINGGOLD: 10095 Medicines Management Unit, Department of Health, Northern Territory Government, Darwin, NT, Australia. RINGGOLD: 1137 Quality Use of Medicine and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia. College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia. RINGGOLD: 198094
Citation	J Telemed Telecare. 2023 Oct 11:1357633X231204545. doi: 10.1177/1357633X231204545.
OrcId	0000-0001-5691-2795
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/37822219/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/12548
Title	Opportunities for clinical decision support targeting medication safety in remote primary care management of chronic kidney disease: A qualitative study in Northern Australia.
Type of document	Journal Article
Entity Type	Publication

Opportunities for clinical decision support targeting medication safety in remote primary care management of chronic kidney disease: A qualitative study in Northern Australia.

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